Summary

On March 22, 2014, an Ebola epidemic was officially declared in Guinea. Over the course of the next year, the virus would infect more than 25,000 people in nine countries and claim more than 10,000 lives, dwarfing all previous Ebola outbreaks. For comparison, the biggest previous outbreak had a total of 425 cases.

The reasons this epidemic escalated so dramatically are varied, and still debated, but some facts are clear. Even very early on, Ebola cases were spread over a wide geographic area. Initial cases were recorded around Guéckédou, but within 10 days of the outbreak being declared cases had been confirmed in Liberia, and hundreds of kilometers away in Conakry, Guinea’s capital. On March 31, Doctors Without Borders/Médecins Sans Frontières (MSF) declared that the outbreak was “unprecedented” in terms of its geographic spread.

Previous outbreaks had mostly occurred in remote rural communities, where they could more easily be contained. This time Ebola quickly appeared in densely populated cities such as Conakry. The virus also emerged at the junction of Guinea, Sierra Leone, and Liberia; an area where people regularly travel across the country borders.

While Ebola has periodically erupted since the 1970s, an outbreak had never before been recorded in this region, leading to early misdiagnoses. The three most-affected countries also had already-weak health systems that were unprepared and ill-equipped to deal with the crisis, fueling further spread of the disease.

MSF’s response to this outbreak was equally unprecedented. Although MSF has helped control Ebola outbreaks in nine countries over the past 20 years, the enormity of this global epidemic tested our limits and prompted one of our biggest-ever emergency responses. By the end of March 2015, MSF had spent close to 99 million dollars in the three worst affected countries of Guinea, Liberia, and Sierra Leone. In previous outbreaks, MSF had only ever needed to operate one Ebola management center (EMC) at a time. During this epidemic, we set up and managed 15 EMCs and transit centers in the three most-affected countries, operating up to eight simultaneously. The largest EMC we had built before this outbreak had 40 beds; in this epidemic we established a 250‑bed EMC, the biggest ever. We responded across the region, in Guinea, Sierra Leone, and Liberia, but also in Mali, Senegal, Nigeria, and an unrelated outbreak in the Democratic Republic of Congo. To scale up the response capacity MSF provided Ebola management training to thousands of people from within MSF, as well as from national governments, the United Nations, and from other nongovernment organizations.

While MSF tried its best to reduce the spread of the virus, it was clear that much more assistance was needed. MSF repeatedly raised the alarm and called for additional support through public statements, media interviews, and stakeholder meetings. Yet the international effort to stem the outbreak remained inadequate, with MSF teams seeing gaps in all aspects of the response. In September MSF’s appeals were escalated to the highest level when International President Dr. Joanne Liu briefed the United Nations in New York, calling for more support from UN member states. Large-scale international assistance was finally deployed towards the end of 2014, when case numbers also began to decline.

Today, cases have plummeted and Liberia has remarkably been declared Ebola-free. However, with new cases emerging each week in Sierra Leone and Guinea, the outbreak is not over. MSF teams are continuing to run EMCs and engage with affected communities to extinguish the final embers of this unprecedented epidemic.